Reverse loading surgical clip applier

ABSTRACT

An end effector for a surgical clip applier includes a body having a proximal end and a distal end, a clip cartridge coupled to the body and containing one or more surgical clips, and a head rotatably coupled to the distal end. First and second jaw members are mounted to the head such that rotation of the head correspondingly moves the first and second jaw members. The head is rotatable between a loading position, where the first and second jaw members are aligned to receive a distal-most surgical clip of the one or more surgical clips, and a clamping position, where the first and second jaw members are positioned to crimp a surgical clip interposing the first and second jaw members.

BACKGROUND

Minimally invasive surgical (MIS) tools and procedures are oftenpreferred over traditional open surgical approaches due to theirpropensity toward reducing post-operative recovery time and leavingminimal scarring. Endoscopic surgery is one type of MIS procedure inwhich a surgical tool operably connected to an elongate shaft isintroduced into the body of a patient through a natural bodily orifice.Laparoscopic surgery is a related type of MIS procedure in which a smallincision is formed in the abdomen of a patient and a trocar is insertedthrough the incision to form a surgical access pathway for a surgicaltool and elongate shaft. Once located within the abdomen, the surgicaltool engages and/or treats tissue in a number of ways to achieve adiagnostic or therapeutic effect. Manipulation and engagement of thesurgical tool may take place via various components passing through theelongate shaft.

One surgical instrument commonly used with a trocar is a surgical clipapplier, which can be used to ligate blood vessels, ducts, shunts, orportions of body tissue during surgery. Traditional surgical clipappliers have a handle and an elongate shaft extending from the handle.A pair of movable opposed jaws is positioned at the end of the elongateshaft for holding and forming a surgical clip or “ligation clip”therebetween. In operation, a user (e.g., a surgeon or clinician)positions the jaws around the vessel or duct and squeezes a trigger onthe handle to close the jaws and thereby collapse the surgical clip overthe vessel.

More recently, however, robotic systems have been developed to assist inMIS procedures. Instead of directly engaging a surgical instrument,users are now able to manipulate and engage surgical instruments via anelectronic interface communicatively coupled to a robotic manipulator.With the advances of robotic surgery, a user need not even be in theoperating room with the patient during the surgery.

Robotic surgical systems are also now capable of utilizing roboticallycontrolled clip appliers. Such clip appliers include features forrobotically feeding and forming surgical clips. Advances andimprovements to the methods and devices for applying surgical clips tovessels, ducts, shunts, etc. is continuously in demand to make theprocess more efficient and safe.

BRIEF DESCRIPTION OF THE DRAWINGS

The following figures are included to illustrate certain aspects of thepresent disclosure, and should not be viewed as exclusive embodiments.The subject matter disclosed is capable of considerable modifications,alterations, combinations, and equivalents in form and function, withoutdeparting from the scope of this disclosure.

FIG. 1 is a block diagram of an example robotic surgical system that mayincorporate some or all of the principles of the present disclosure.

FIG. 2 is an isometric top view of an example surgical tool that mayincorporate some or all of the principles of the present disclosure.

FIG. 3 is an isometric bottom view of the surgical tool of FIG. 2.

FIG. 4 is an exploded view of the elongate shaft and the end effector ofthe surgical tool of FIGS. 2 and 3.

FIG. 5 is an exposed isometric view of the surgical tool of FIG. 2.

FIG. 6 is a side view of an example surgical tool that may incorporatesome or all of the principles of the present disclosure.

FIG. 7 illustrates potential degrees of freedom in which the wrist ofFIG. 1 may be able to articulate (pivot).

FIG. 8 is an enlarged isometric view of the distal end of the surgicaltool of FIG. 6.

FIG. 9 is a bottom view of the drive housing of the surgical tool ofFIG. 6.

FIG. 10 is an isometric exposed view of the interior of the drivehousing of the surgical tool of FIG. 6.

FIG. 11 is an enlarged isometric view of an example end effector.

FIGS. 12A-12D are progressive isometric views of the end effector ofFIG. 11 during example loading operation.

FIGS. 13A-13B are exposed, partial cross-sectional side views of the endeffector of FIG. 11 during example operation.

FIG. 14 is an isometric view of another example embodiment of the endeffector of FIG. 11.

DETAILED DESCRIPTION

The present disclosure is related to surgical systems and, moreparticularly, to surgical clip appliers with jaws that are rotatable tofeed surgical clips between opposed jaw members.

Embodiments discussed herein describe improvements to clip applier endeffectors. The end effectors described herein include a body having aproximal end and a distal end, a clip cartridge coupled to the body andcontaining one or more surgical clips, and a head rotatably coupled tothe distal end. First and second jaw members are mounted to the headsuch that rotation of the head correspondingly moves the first andsecond jaw members. The head may be rotatable between a loadingposition, where the first and second jaw members are aligned to receivea distal-most surgical clip of the one or more surgical clips, and aclamping position, where the first and second jaw members are positionedto crimp a surgical clip interposing the first and second jaw members.

In contrast to conventional clip appliers, the surgical clips may bereceived by the jaw members crown first, which helps mitigate catchingthe surgical clips on any sharp corners that might obstruct their distaladvancement. Moreover, the presently described jaw members may compriseindependent or separate plate-like structures that may proveadvantageous in facilitating parallel closure of the jaw members, whichcan reduce the force required to crimp a surgical clip.

FIG. 1 is a block diagram of an example robotic surgical system 100 thatmay incorporate some or all of the principles of the present disclosure.As illustrated, the system 100 can include at least one mastercontroller 102 a and at least one arm cart 104. The arm cart 104 may bemechanically and/or electrically coupled to a robotic manipulator and,more particularly, to one or more robotic arms 106 or “tool drivers”.Each robotic arm 106 may include and otherwise provide a location formounting one or more surgical tools or instruments 108 for performingvarious surgical tasks on a patient 110. Operation of the robotic arms106 and instruments 108 may be directed by a clinician 112 a (e.g., asurgeon) from the master controller 102 a.

In some embodiments, a second master controller 102 b (shown in dashedlines) operated by a second clinician 112 b may also direct operation ofthe robotic arms 106 and instruments 108 in conjunction with the firstclinician 112 a. In such embodiments, for example, each clinician 102a,b may control different robotic arms 106 or, in some cases, completecontrol of the robotic arms 106 may be passed between the clinicians 102a,b. In some embodiments, additional arm carts (not shown) havingadditional robotic arms (not shown) may be utilized during surgery on apatient 110, and these additional robotic arms may be controlled by oneor more of the master controllers 102 a,b.

The arm cart 104 and the master controllers 102 a,b may be incommunication with one another via a communications link 114, which maybe any type of wired or wireless telecommunications means configured tocarry a variety of communication signals (e.g., electrical, optical,infrared, etc.) according to any communications protocol.

The master controllers 102 a,b generally include one or more physicalcontrollers that can be grasped by the clinicians 112 a,b andmanipulated in space while the surgeon views the procedure via a stereodisplay. The physical controllers generally comprise manual inputdevices movable in multiple degrees of freedom, and which often includean actuatable handle for actuating the surgical instrument(s) 108, forexample, for opening and closing opposing jaws, applying an electricalpotential (current) to an electrode, or the like. The master controllers102 a,b can also include an optional feedback meter viewable by theclinicians 112 a,b via a display to provide a visual indication ofvarious surgical instrument metrics, such as the amount of force beingapplied to the surgical instrument (i.e., a cutting instrument ordynamic clamping member).

Example implementations of robotic surgical systems, such as the system100, are disclosed in U.S. Pat. No. 7,524,320, the contents of which areincorporated herein by reference. The various particularities of suchdevices will not be described in detail herein beyond that which may benecessary to understand the various embodiments and forms of the variousembodiments of robotic surgery apparatus, systems, and methods disclosedherein.

FIG. 2 is an isometric top view of an example surgical tool 200 that mayincorporate some or all of the principles of the present disclosure. Thesurgical tool 200 may be the same as or similar to the surgicalinstrument(s) 108 of FIG. 1 and, therefore, may be used in conjunctionwith the robotic surgical system 100 of FIG. 1. Accordingly, thesurgical tool 200 may be designed to be releasably coupled to a roboticarm 106 (FIG. 1) of a robotic manipulator of the robotic surgical system100. Full detail and operational description of the surgical tool 200 isprovided in U.S. Patent Pub. 2016/0287252, entitled “Clip ApplierAdapted for Use with a Surgical Robot,” the contents of which are herebyincorporated by reference in their entirety.

While the surgical tool 200 is described herein with reference to arobotic surgical system, it is noted that the principles of the presentdisclosure are equally applicable to non-robotic surgical tools or, morespecifically, manually operated surgical tools. Accordingly, thediscussion provided herein relating to robotic surgical systems merelyencompasses one example application of the presently disclosed inventiveconcepts.

As illustrated, the surgical tool 200 can include an elongate shaft 202,an end effector 204 coupled to the distal end of the shaft 202, and adrive housing 206 coupled to the proximal end of the shaft 202. Theterms “proximal” and “distal” are defined herein relative to a roboticsurgical system having an interface configured to mechanically andelectrically couple the surgical tool 200 (e.g., the drive housing 206)to a robotic manipulator. The term “proximal” refers to the position ofan element closer to the robotic manipulator and the term “distal”refers to the position of an element closer to the end effector 204 andthus further away from the robotic manipulator. Moreover, the use ofdirectional terms such as above, below, upper, lower, upward, downward,left, right, and the like are used in relation to the illustrativeembodiments as they are depicted in the figures, the upward or upperdirection being toward the top of the corresponding figure and thedownward or lower direction being toward the bottom of the correspondingfigure.

In applications where the surgical tool 200 is used in conjunction witha robotic surgical system (e.g., system 100 of FIG. 1), the drivehousing 206 can include a tool mounting portion 208 designed withfeatures that releasably couple the surgical tool 200 to a robotic arm(e.g., the robotic arms 106 or “tool drivers” of FIG. 1) of a roboticmanipulator. The tool mounting portion 208 may releasably attach(couple) the drive housing 206 to a tool driver in a variety of ways,such as by clamping thereto, clipping thereto, or slidably matingtherewith. In some embodiments, the tool mounting portion 208 mayinclude an array of electrical connecting pins, which may be coupled toan electrical connection on the mounting surface of the tool driver.While the tool mounting portion 208 is described herein with referenceto mechanical, electrical, and magnetic coupling elements, it should beunderstood that a wide variety of telemetry modalities might be used,including infrared, inductive coupling, or the like.

FIG. 3 is an isometric bottom view of the surgical tool 200. Thesurgical tool 200 further includes an interface 302 that mechanicallyand electrically couples the tool mounting portion 208 to a roboticmanipulator. In various embodiments, the tool mounting portion 208includes a tool mounting plate 304 that operably supports a plurality ofdrive inputs, shown as a first drive input 306 a, a second drive input306 b, and a third drive input 306 c. While only three drive inputs 306a-c are shown in FIG. 3, more or less than three may be employed,without departing from the scope of the disclosure.

In the illustrated embodiment, each drive input 306 a-c comprises arotatable disc configured to align with and couple to a correspondinginput actuator (not shown) of a given tool driver. Moreover, each driveinput 306 a-c provides or defines one or more surface features 308configured to align with mating surface features provided on thecorresponding input actuator. The surface features 308 can include, forexample, various protrusions and/or indentations that facilitate amating engagement.

FIG. 4 is an exploded view of one example of the elongate shaft 202 andthe end effector 204 of the surgical tool 200 of FIGS. 2 and 3,according to one or more embodiments. As illustrated, the shaft 202includes an outer tube 402 that houses the various components of theshaft 202, which can include a jaw retaining assembly 404. The jawretaining assembly 404 includes a jaw retainer shaft 406 with a cliptrack 408 and a push rod channel 410 formed thereon. The end effector204 includes opposing jaws 412 that are configured to mate to a distalend of the clip track 408.

The shaft 202 also includes a clip advancing assembly, which, in oneexample embodiment, can include a feeder shoe 414 adapted to be slidablydisposed within the clip track 408. The feeder shoe 414 is designed toadvance a series of clips 416 positioned within the clip track 408, anda feedbar 418 is adapted to drive the feeder shoe 414 through the cliptrack 408. An advancer assembly 420 is adapted to mate to a distal endof the feedbar 418 for advancing a distal-most clip into the jaws 412.

The shaft 202 furthers include a clip forming or camming assemblyoperable to collapse the jaws 412 and thereby crimp (crush) a surgicalclip 416 positioned between (interposing) the jaws 412. The cammingassembly includes a cam 422 that slidably mates to the jaws 412, and apush rod 424 that moves the cam 422 relative to the jaws 412 to collapsethe jaws 412. A tissue stop 426 can mate to a distal end of the cliptrack 408 to help position the jaws 412 relative to a surgical site.

The jaw retainer shaft 406 is extendable within and couples to the outertube 402 at a proximal end 428 a, and its distal end 428 b is adapted tomate with the jaws 412. The push rod channel 410 formed on the jawretainer shaft 406 may be configured to slidably receive the push rod424, which is used to advance the cam 422 over the jaws 412. The cliptrack 408 extends distally beyond the distal end 428 b of the jawretainer shaft 406 to allow a distal end of the clip track 408 to besubstantially aligned with the jaws 412.

The clip track 408 can include several openings 430 formed therein forreceiving an upper or “superior” tang 432 a formed on the feeder shoe414 adapted to be disposed within the clip track 408. The clip track 408can also include a stop tang 434 formed thereon that is effective to beengaged by a corresponding stop tang formed on the feeder shoe 414 toprevent movement of the feeder shoe 414 beyond a distal-most position.To facilitate proximal movement of the feeder shoe 414 within the cliptrack 408, the feeder shoe 414 can also include a lower or “inferior”tang 432 b formed on the underside thereof for allowing the feeder shoe414 to be engaged by the feedbar 418 as the feedbar 418 is moveddistally. In use, each time the feedbar 418 is moved distally, a detentformed in the feedbar 418 engages the inferior tang 432 b and moves thefeeder shoe 414 distally a predetermined distance within the clip track408. The feedbar 418 can then be moved proximally to return to itsinitial position, and the angle of the inferior tang 432 b allows theinferior tang 432 b to slide into the next detent formed in the feedbar418.

The jaws 412 include first and second opposed jaw members that aremovable (collapsible) relative to one another and are configured toreceive a surgical clip from the series of clips 416 therebetween. Thejaw members can each include a groove formed on opposed inner surfacesthereof for receiving the legs of a surgical clip 416 in alignment withthe jaw members. In the illustrated embodiment, the jaw members arebiased to an open position and a force is required to urge the jawmembers toward one another to crimp the interposing clip 416. The jawmembers can also each include a cam track formed thereon for allowingthe cam 422 to slidably engage and move the jaw members toward oneanother. A proximal end 436 a of the cam 422 is matable with a distalend 438 a of the push rod 424, and a distal end 436 b of the cam 422 isadapted to engage and actuate the jaws 412. The proximal end 438 b ofthe push rod 424 is matable with a closure link assembly associated withthe drive housing 206 for moving the push rod 424 and the cam 422relative to the jaws 412.

The distal end 436 b of the cam 422 includes a camming channel ortapering recess formed therein for slidably receiving corresponding camtracks provided by the jaw members. In operation, the cam 422 isadvanced from a proximal position, in which the jaw members are spacedapart from one another, to a distal position, where the jaw members arecollapsed to a closed position. As the cam 422 is advanced over the jawmembers, the tapering recess at the distal end 436 b serves to push thejaw members toward one another, thereby crimping a surgical clip 416disposed therebetween.

FIG. 5 is an exposed isometric view of the surgical tool 200 of FIG. 2,according to one or more embodiments. The shroud or covering of thedrive housing 206 has been removed to reveal the internal componentparts. As illustrated, the surgical tool 200 may include a first drivegear 502 a, a second drive gear 502 b, and a third drive gear 502 c. Thefirst drive gear 502 a may be operatively coupled to (or extend from)the first drive input 306 a (FIG. 3) such that actuation of the firstdrive input 306 a correspondingly rotates the first drive gear 502 a.Similarly, the second and third drive gears 502 b,c may be operativelycoupled to (or extend from) the second and third drive inputs 306 b,c(FIG. 3), respectively, such that actuation of the second and thirddrive inputs 306 b,c correspondingly rotates the second and third drivegears 502 b,c, respectively.

The first drive gear 502 a may be configured to intermesh with a firstdriven gear 504 a, which is operatively coupled to the shaft 202. In theillustrated embodiment, the driven gear 504 a comprises a helical gear.In operation, rotation of the first drive gear 502 a about a first axiscorrespondingly rotates the first driven gear 504 a about a second axisorthogonal to the first axis to control rotation of the shaft 202 inclockwise and counter-clockwise directions based on the rotationaldirection of the first drive gear 502 a.

The second drive gear 502 b may be configured to intermesh with a seconddriven gear 504 b (partially visible in FIG. 5), and the third drivegear 502 c may be configured to intermesh with a third driven gear 504c. In the illustrated embodiment, the second and third drive and drivengears 502 b,c, 504 b,c comprise corresponding rack and pinioninterfaces, where the driven gears 504 b,c comprise the rack and thedrive gears 502 b,c comprise the pinion. Independent rotation of thesecond and third drive gears 502 b,c will cause the second and thirddriven gears 504 b,c, respectively, to translate linearly relative to(independent of) one another.

In at least one embodiment, actuation (rotation) of the third drive gear502 c will result in a surgical clip 416 (FIG. 4) being fed into thejaws 412. More particularly, the third driven gear 504 c may beoperatively coupled to the feedbar 418 (FIG. 4) and, upon rotation ofthe third drive gear 502 c in a first angular direction, the thirddriven gear 504 c will advance distally and correspondingly advance thefeedbar 418 a sufficient distance to fully advance a surgical clip intothe jaws 412. Rotation of the third drive gear 502 c may be preciselycontrolled by an electrical and software interface to deliver the exactlinear travel to the third driven gear 504 c necessary to feed a clip416 into the jaws 412.

Upon delivery of a clip into the jaws 412, or after a predeterminedamount of rotation of the third drive gear 502 c, rotation of the thirddrive gear 502 c is reversed in a second angular direction to move thethird driven gear 504 c linearly in a proximal direction, whichcorrespondingly moves the feedbar 418 proximally. This process may berepeated several times to accommodate a predetermined number of clipsresiding in the shaft 202.

Actuation of the second drive gear 502 b causes the jaws 412 to close orcollapse to crimp a surgical clip. More particularly, the second drivengear 504 b may be coupled to the proximal end 438 b (FIG. 4) of the pushrod 424 (FIG. 4) and, upon actuation of the second drive gear 502 b in afirst angular direction, the second driven gear 504 b will be advancedlinearly in a distal direction and correspondingly drive the push rod424 distally, which drives the cam 422 over the jaws 412 to collapse thejaw members and crimp a surgical clip positioned in the jaws 412. Once asurgical clip is successfully deployed, rotation of the second drivegear 502 b is reversed in the opposite angular direction to move thesecond driven gear 504 b in a proximal direction, which correspondinglymoves the push rod 424 and the cam 422 proximally and permits the jaws412 to open once again.

The processes of delivering a surgical clip into the jaws 412 andcollapsing the jaws 412 to crimp the surgical clip are not limited tothe actuation mechanisms and structures described herein. In alternativeembodiments, for example, the second and third driven gears 504 b,c mayinstead comprise capstan pulleys configured to route and translate drivecables within the shaft 202. In such embodiments, the drive cables maybe operatively coupled to one or more lead screws or other types ofrotating members positioned within the shaft 202 near the distal end andcapable of advancing the feedbar 418 to deliver a surgical clip into thejaws 412 and advancing the cam 422 to collapse the jaws 412 and crimpthe surgical clip.

FIG. 6 is an isometric top view of another example surgical tool 600that may incorporate some or all of the principles of the presentdisclosure. Similar to the surgical tool 200 of FIG. 2, the surgicaltool 600 may be used in conjunction with the robotic surgical system 100of FIG. 1. As illustrated, the surgical tool 600 includes an elongateshaft 602, an end effector 604 positioned at the distal end of the shaft602, a wrist 606 (alternately referred to as a “articulable wristjoint”) that couples the end effector 604 to the distal end of the shaft602, and a drive housing 608 coupled to the proximal end of the shaft602. In some embodiments, the shaft 602, and hence the end effector 604coupled thereto, is configured to rotate about a longitudinal axis A₁.

In the illustrated embodiment, the end effector 604 comprises a clipapplier that includes opposing jaw members 610, 612 configured tocollapse toward one another to crimp a surgical clip. The wrist 606comprises an articulatable joint that facilitates pivoting movement ofthe end effector 604 relative to the shaft 602 to position the endeffector 604 at desired orientations and locations relative to asurgical site. The housing 608 includes (contains) various actuationmechanisms designed to control articulation and operation of the endeffector 604.

FIG. 7 illustrates the potential degrees of freedom in which the wrist606 may be able to articulate (pivot). The degrees of freedom of thewrist 606 are represented by three translational variables (i.e., surge,heave, and sway), and by three rotational variables (i.e., Euler anglesor roll, pitch, and yaw). The translational and rotational variablesdescribe the position and orientation of a component of a surgicalsystem (e.g., the end effector 604) with respect to a given referenceCartesian frame. As depicted in FIG. 7, “surge” refers to forward andbackward translational movement, “heave” refers to translationalmovement up and down, and “sway” refers to translational movement leftand right. With regard to the rotational terms, “roll” refers to tiltingside to side, “pitch” refers to tilting forward and backward, and “yaw”refers to turning left and right.

The pivoting motion can include pitch movement about a first axis of thewrist 606 (e.g., X-axis), yaw movement about a second axis of the wrist606 (e.g., Y-axis), and combinations thereof to allow for 360°rotational movement of the end effector 604 about the wrist 606. Inother applications, the pivoting motion can be limited to movement in asingle plane, e.g., only pitch movement about the first axis of thewrist 606 or only yaw movement about the second axis of the wrist 606,such that the end effector 604 moves only in a single plane.

Referring again to FIG. 6, the surgical tool 600 includes a plurality ofdrive cables (generally obscured in FIG. 6) that form part of a cabledriven motion system configured to facilitate operation and articulation(movement) of the end effector 604 relative to the shaft 602. Forexample, selectively moving the drive cables can actuate the endeffector 604 and thereby collapse the jaw members 610, 612 toward eachother. Moreover, moving the drive cables can also move the end effector604 between an unarticulated position and an articulated position. Theend effector 604 is depicted in FIG. 6 in the unarticulated positionwhere a longitudinal axis A₂ of the end effector 604 is substantiallyaligned with the longitudinal axis A₁ of the shaft 602, such that theend effector 604 is at a substantially zero angle relative to the shaft602. In the articulated position, the longitudinal axes A₁, A₂ would beangularly offset from each other such that the end effector 604 is at anon-zero angle relative to the shaft 602.

FIG. 8 is an enlarged isometric view of the distal end of the surgicaltool 600 of FIG. 6. More specifically, FIG. 8 depicts an enlarged andpartially exploded view of the end effector 604 and the wrist 606. Thewrist 606 operatively couples the end effector 604 to the shaft 602. Toaccomplish this, the wrist 606 includes a distal clevis 802 a, aproximal clevis 802 b, and a spacer 803 interposing the distal andproximal clevises 802 a,b. The end effector 604 is coupled to the distalclevis 802 a and the distal clevis 802 a is rotatably mounted to thespacer 803 at a first axle 804 a. The spacer 803 is rotatably mounted tothe proximal clevis 802 b at a second axle 804 b and the proximal clevis802 b is coupled to a distal end 806 of the shaft 602.

The wrist 606 provides a first pivot axis P₁ that extends through thefirst axle 804 a and a second pivot axis P₂ that extends through thesecond axle 804 b. The first pivot axis P₁ is substantiallyperpendicular (orthogonal) to the longitudinal axis A₂ of the endeffector 604, and the second pivot axis P₂ is substantiallyperpendicular (orthogonal) to both the longitudinal axis A₂ and thefirst pivot axis P₁. Movement about the first pivot axis P₁ provides“pitch” articulation of the end effector 604, and movement about thesecond pivot axis P₂ provides “yaw” articulation of the end effector604.

A plurality of drive cables 808 extend longitudinally within the shaft602 and pass through the wrist 106 to be operatively coupled to the endeffector 604. The drive cables 808 form part of the cable driven motionsystem briefly described above, and may be referred to and otherwisecharacterized as cables, bands, lines, cords, wires, ropes, strings,twisted strings, elongate members, etc. The drive cables 808 can be madefrom a variety of materials including, but not limited to, metal (e.g.,tungsten, stainless steel, etc.) or a polymer.

The drive cables 808 extend proximally from the end effector 604 to thedrive housing 608 (FIG. 6) where they are operatively coupled to variousactuation mechanisms or devices housed (contained) therein to facilitatelongitudinal movement (translation) of the drive cables 808. Selectiveactuation of the drive cables 808 causes the end effector 604 toarticulate (pivot) relative to the shaft 602. Moving a given drive cable808 constitutes applying tension (i.e., pull force) to the given drivecable 808 in a proximal direction, which causes the given drive cable808 to translate and thereby cause the end effector 604 to move(articulate) relative to the shaft 602.

One or more actuation cables 810, shown as first actuation cables 810 aand second actuation cables 810 b, may also extend longitudinally withinthe shaft 602 and pass through the wrist 106 to be operatively coupledto the end effector 604. The actuation cables 810 a,b may be similar tothe drive cables 808 and also form part of the cable driven motionsystem. Selectively actuating the actuation cables 810 a,b causes theend effector 604 to actuate, such as collapsing the first and second jawmembers 610, 612 to crimp a surgical clip (not shown).

More specifically, the actuation cables 810 a,b may be operativelycoupled to a cam 812 that is slidably engageable with the jaw members610, 612. One or more pulleys 814 may be used to receive and redirectthe first actuation cables 810 a for engagement with the cam 812.Longitudinal movement of the first actuation cables 810 acorrespondingly moves the cam 812 distally relative to the jaw members610, 612. The distal end of the cam 812 includes a tapering recess orcamming channel 816 formed therein for slidably receiving correspondingcam tracks 818 provided by the jaw members 610, 612. As the cam 812 isadvanced distally, the camming channel 816 pushes (collapses) the jawmembers 610, 612 toward one another, thereby crimping a surgical clip(not shown) disposed therebetween. Actuation of the second actuationcables 810 b (one shown) pulls the cam 812 proximally, thereby allowingthe jaw members 610, 612 to open again to receive another surgical clip.

Although not expressly depicted in FIG. 8, an assembly including, forexample, a feedbar, a feeder shoe, and a clip track may be included ator near the end effector 604 to facilitate feeding surgical clips intothe jaw members 610, 612. In some embodiments, the feedbar (or aconnecting member) may be flexible and extend through the wrist 606.

FIG. 9 is a bottom view of the drive housing 608, according to one ormore embodiments. As illustrated, the drive housing 608 may include atool mounting interface 902 used to operatively couple the drive housing608 to a tool driver of a robotic manipulator. The tool mountinginterface 902 may mechanically, magnetically, and/or electrically couplethe drive housing 608 to a tool driver.

As illustrated, the interface 902 includes and supports a plurality ofdrive inputs, shown as drive inputs 906 a, 906 b, 906 c, 906 d, 906 e,and 906 f. Each drive input 906 a-f may comprise a rotatable discconfigured to align with and couple to a corresponding input actuator(not shown) of a tool driver. Moreover, each drive input 906 a-fprovides or defines one or more surface features 908 configured to alignwith mating features provided on the corresponding input actuator. Thesurface features 908 can include, for example, various protrusionsand/or indentations that facilitate a mating engagement.

In some embodiments, actuation of the first drive input 906 a maycontrol rotation of the elongate shaft 602 about its longitudinal axisA₁. Depending on the rotational actuation of the first drive input 906a, the elongate shaft 602 may be rotated clockwise or counter-clockwise.In some embodiments, selective actuation of the second and third driveinputs 906 b,c may cause movement (axial translation) of the actuationcables 810 a,b (FIG. 8), which causes the cam 812 (FIG. 8) to move andcrimp a surgical clip, as generally described above. In someembodiments, actuation of the fourth drive input 906 d feeds a surgicalclip into the jaw members 610, 612 (FIG. 8). In some embodiments,actuation of the fifth and sixth drive inputs 906 e,f causes movement(axial translation) of the drive cables 808 (FIG. 8), which results inarticulation of the end effector 604. Each of the drive inputs 906 a-fmay be actuated based on user inputs communicated to a tool drivercoupled to the interface 902, and the user inputs may be received via acomputer system incorporated into the robotic surgical system.

FIG. 10 is an isometric exposed view of the interior of the drivehousing 608, according to one or more embodiments. Several componentparts that may otherwise be contained within the drive housing 608 arenot shown in FIG. 10 to enable discussion of the depicted componentparts.

As illustrated, the drive housing 608 contains a first capstan 1002 a,which is operatively coupled to or extends from the first drive input906 a (FIG. 9) such that actuation of the first drive input 906 aresults in rotation of the first capstan 1002 a. A helical drive gear1004 is coupled to or forms part of the first capstan 1002 a and isconfigured to mesh and interact with a driven gear 1006 operativelycoupled to the shaft 602 such that rotation of the driven gear 1006correspondingly rotates the shaft 602. Accordingly, rotation of thehelical drive gear 1004 (via actuation of the first drive input 906 a ofFIG. 9) will drive the driven gear 1006 and thereby control rotation ofthe elongate shaft 602 about the longitudinal axis A₁.

The drive housing 608 also includes second and third capstans 1002 b and1002 c operatively coupled to or extending from the second and thirddrive inputs 906 b,c (FIG. 9), respectively, such that actuation of thesecond and third drive inputs 906 b,c results in rotation of the secondand third capstans 1002 b,c. The second and third capstans 1002 b,ccomprise capstan pulleys operatively coupled to the actuation cables 810a,b (FIG. 8) such that rotation of a given capstan 1002 b,c actuates(longitudinally moves) a corresponding one of the actuation cables 810a,b. Accordingly, selective rotation of the second and third capstans1002 b,c via actuation of the second and third drive inputs 906 b,c,respectively, will cause movement (axial translation) of the actuationcables 810 a,b, which causes the cam 812 (FIG. 8) to move and crimp asurgical clip.

The drive housing 608 further includes a fourth capstan 1002 d, which isoperatively coupled to or extends from the fourth drive input 906 d(FIG. 9) such that actuation of the fourth drive input 906 d results inrotation of the fourth capstan 1002 d. A spur gear 1008 is coupled to orforms part of the fourth capstan 1002 d and is configured to mesh andinteract with a rack gear (not shown) also contained within the drivehousing 608. The rack gear may be operatively coupled to a feedbar (oranother connecting member) which facilitates operation of a feeder shoeand associated clip track to feed surgical clips into the jaw members610, 612 (FIGS. 6 and 8). Accordingly, rotation of the spur gear 1008(via actuation of the fourth drive input 906 d) will control the feedbarand thereby control loading of surgical clips into the jaw members 610,612 as desired.

The drive housing 608 further contains or houses fifth and sixthcapstans 1002 e and 1002 f operatively coupled to or extending from thefifth and sixth drive inputs 906 e,f (FIG. 9), respectively, such thatactuation of the fifth and sixth drive inputs 906 e,f results inrotation of the fifth and sixth capstans 1002 e,f.

The fifth and sixth capstans 1002 e,f comprise capstan pulleysoperatively coupled to the drive cables 808 (FIG. 8) such that rotationof a given capstan 1002 e,f actuates (longitudinally moves) acorresponding one of the actuation cables 808. Accordingly, selectiverotation of the fifth and sixth capstans 1002 e,f via actuation of thefifth and sixth drive inputs 906 e,f, respectively, will cause movement(axial translation) of the drive cables 808 and thereby articulate(pivot) the end effector 604 relative to the shaft 602.

The surgical tools 200, 600 described herein above may incorporate andfacilitate the principles of the present disclosure in improving feedingand/or forming of surgical clips in robotic clip appliers. Moreover, itis contemplated herein to combine some or all of the features of thesurgical tools 200, 600 to facilitate operation of the embodimentsdescribed herein. Accordingly, example surgical tools that mayincorporate the principles of the present disclosure may include gearedactuators, capstan pulley and cable actuators, or any combinationthereof, without departing from the scope of the disclosure.

FIG. 11 is an enlarged isometric view of an example end effector 1102,according to one or more embodiments the present disclosure. The endeffector 1102 may be similar in some respects to the end effectors 204and 604 of FIGS. 2 and 6, respectively. Similar to the end effectors204, 604, for example, the end effector 1102 may be incorporated intoeither or both of the surgical tools 200, 600 described herein above.Moreover, the end effector 1102 may comprise a clip applier havingopposed jaw members 1104 and 1106 configured to collapse toward oneanother to crimp a surgical clip. As described herein, the end effector1102 may incorporate various component parts and actuatable mechanismsor features that facilitate the feeding of a surgical clip into the jawmembers 1104, 1106 and collapsing the jaw members 1104, 1106 to crimpthe surgical clip when desired.

As illustrated, the end effector 1102 includes an elongate body 1108having a proximal end 1110 a and a distal end 1110 b. In someembodiments, the proximal end 1110 a may be operatively coupled to anelongate shaft of a surgical tool, such as the shaft 202 of the surgicaltool 200 of FIG. 2. In other embodiments, however, the proximal end 1110a may be operatively coupled to an articulable wrist joint, such as thewrist 606 of the surgical tool 600 of FIG. 6.

The end effector 1102 includes a head 1112 positioned or otherwiseincluded at the distal end 1110 b of body 1108. The head 1112 may berotatably coupled to the body 1108 at a hinge or axle 1114, and the jawmembers 1104, 1106 may be incorporated into or otherwise form part ofthe head 1112 such that rotation of the head 1112 on the axle 1114correspondingly moves the jaw members 1104, 1106 in the same angulardirection.

A pivot axis P₁ extends through the axle 1114 and is substantiallyperpendicular to a longitudinal axis A₁ of the effector 1102. The head1112 may be pivotable about the pivot axis P₁ between a loadingposition, where the jaw members 1104, 1106 are positioned to receive asurgical clip, and a clamping position, where the jaw members 1104, 1106are positioned and otherwise poised to clamp (crimp) a surgical clip ata desired location. As will be appreciated, the clamping position may beany angular position away from the loading position and relative to thelongitudinal axis A₁ of the effector 1102 where the jaw members 1104,1106 are able to properly crimp a surgical clip at a desired location.Accordingly, it is contemplated herein to deploy (crimp) a surgical clipat any angular location as long as it does not interfere with cliploading at the loading position. As will be appreciated, one advantageof the angular versatility of the head 1112 is that a user may be ableto position the jaw members 1104, 1106 in a reverse position (i.e.,retroflexion and/or retroflex articulation) relative to target tissue,which increases the maneuverability.

In some embodiments, the range of potential angular movement of the head1112 may be about 180°. In such embodiments, the clamping position maycomprise any angle between the loading position and 180° from theloading position. In practice, however, and to account for the loadingposition, the clamping position may comprise any angle between 0° andabout 160° relative to the longitudinal axis A₁. In other embodiments,however, the range of potential angular movement of the head 1112 may be360°. In such embodiments, the head 1112 may be capable of pivotingthrough the loading position in either angular direction and theclamping position may comprise virtually any angle relative to thelongitudinal axis A₁. In embodiments where the head 1112 does not pivotthrough the loading position in either angular direction, and to accountfor the loading position, the clamping position may comprise any anglebetween 0° and about 160° in in either angular direction relative to thelongitudinal axis A₁.

The end effector 1102 further includes a clip cartridge 1116 coupled tothe body 1108 proximal to the head 1112 and configured to house one ormore surgical clips 1118 (one partially shown). In some embodiments, theclip cartridge 1116 may be removably coupled to the body 1108, such asthrough the use of one or more mechanical fasteners (e.g., screws), aninterference fit, a snap fit, any combination thereof, or the like. Insuch embodiments, the clip cartridge 1116 may be removed from the body1108 when the supply of surgical clips 1118 is exhausted. The clipcartridge 1116 may then either be replaced with a new cartridgecontaining additional surgical clips, or additional surgical clips 1118may be added to the clip cartridge 1116, which may then be reattached tothe body 1108 for further operation. In other embodiments, however, theclip cartridge 1116 may form an integral part of the body 1108. In suchembodiments, when the supply of surgical clips 1118 is exhausted the endeffector 1102 may be replaced with a new end effector having a freshsupply of surgical clips.

FIGS. 12A-12D depict progressive isometric views of the end effector1102 during an example clip loading operation, according to one or moreembodiments of the disclosure. In FIG. 12A, the head 1112 is shown inthe process of being moved or rotated (pivoted) about the pivot axis P₁toward the loading position where the jaw members 1104, 1106 becomealigned or substantially aligned with a distal-most surgical clip 1118to be received by the jaw members 1104, 1106. The distal-most surgicalclip 1118 may be one of a plurality of surgical clips 1118 containedwithin the clip cartridge 1116, or may alternatively be the only or lastsurgical clip 1118 contained within the clip cartridge 1116. The meansfor actuating the head 1112 between the clamping and loading positionswill be discussed in further detail below.

The clip cartridge 1116 may define an opening 1202 through which thesurgical clips 1118 are discharged to be received by the jaw members1104, 1106. In some embodiments, as illustrated, the crown of thedistal-most surgical clip 1118 may protrude a short distance through theopening 1202 prior to being discharged from the clip cartridge 1116. Insuch embodiments, the opening 1202 may be slightly smaller than thedimensions of the surgical clip 1118 to prevent the surgical clip 1118from prematurely or inadvertently advancing out of the clip cartridge1116. In other embodiments, however, the distal-most surgical clip 1118may be contained wholly within the clip cartridge 1116 prior to beingdischarged from the clip cartridge 1116 via the opening 1202.

In FIG. 12B, the head 1112 is shown as having moved (pivoted) to theloading position where the jaw members 1104, 1106 are generally alignedwith the distal-most surgical clip 1118. In some embodiments, each jawmember 1104, 1106 can include a channel or groove 1206 (better seen inFIG. 13A) formed on opposed inner surfaces thereof for receiving thedistal-most surgical clip 1118. In such embodiments, the grooves 1206may prove advantageous in helping to capture and maintain the surgicalclip 1118 in a known position between the jaw members 1104, 1106. Inother embodiments, however, the grooves 1206 may be omitted and thedistal-most surgical clip 1118 may instead be captured or held by thejaw members 1104, 1106 via an interference fit or the like.

In some embodiments, the end effector 1102 may include a hard stop 1208configured to receive and stop pivoting motion of the head 1112 at theloading position. In at least one embodiment, the body 1108 of the endeffector 1102 may provide or define the hard stop 1208, but the hardstop 1208 may alternatively be a structure coupled to the body 1108. Thehard stop 1208 may prove advantageous in helping maintain consistentloading alignment for the surgical clips 1118. In other embodiments,however, the hard stop 1208 may be omitted and the actuation mechanismsthat facilitate pivoting movement of the head 1112 may be configured toprecisely align the jaw members 1104, 1106 with the distal-most surgicalclip 1118.

The clip cartridge 1116 is depicted in FIG. 12B in phantom and therebyexposing a set 1204 of surgical clips 1118 that might be containedwithin the clip cartridge 1116. While seven surgical clips 1118 areshown in the set 1204, it will be appreciated that more or less thanseven may be contained within the clip cartridge 1116, without departingfrom the scope of the disclosure. Indeed, in at least one embodiment,the set 1204 may comprise a single surgical clip 1118.

Each surgical clip 1118 includes a crown 1210 (alternately referred toas an “apex”) and a pair of legs 1212 extending longitudinally from thecrown 1210. As illustrated, the surgical clips 1118 are positionedend-to-end within the clip cartridge 1116 with the legs 1212 of the moredistal surgical clips 1118 resting on the crown 1210 of the moreproximal surgical clips 1118. Accordingly, the surgical clips 1118 arearranged within the clip cartridge 1116 with the crown 1210 leading andthe legs 1212 extending proximally therefrom. As a result, the surgicalclips 1118 are fed crown 1210 first into the jaw members 1104, 1106. Incontrast, conventional robotic clip appliers typically feed surgicalclips legs first into opposed jaw members. Surgical clips are commonlydesigned to exhibit a slight taper, where the angle of the legs 1212extending from the crown 1210 converge. This helps facilitate wedgingthe clips into the jaws legs first. One disadvantage of this clip designis that it reduces the clip-to-jaw retention capability since the legsare more tapered than the jaw. This also reduces allowable tip widthbetween the jaw members, which correspondingly limits the size of tissuethat can be treated.

Feeding the surgical clips 1118 crown first 1210 into the jaw members1104, 1106 advantageously helps mitigate the surgical clips 1118 fromgetting caught on any sharp corners or the like that might obstructtheir distal advancement. In embodiments including the grooves 1206(FIGS. 12B and 13A) defined on each jaw member 1104, 1106, the legs 1212may spring outward and seat themselves within the grooves 1206 afterhaving exited the clip cartridge 1116 by bypassing the smaller-sizedopening 1202. Moreover, feeding the surgical clips 1118 crown first 1210into the jaw members 1104, 1106 allows a clip design where the legs 1212can diverge, which increases clip to jaw retention and maximizes theallowable tip width between the jaw members 1104, 1106, and therebyincreasing the size of tissue that can be treated.

In FIG. 12C, the distal-most surgical clip 1118 has been advanceddistally out of the clip cartridge 1116 and received by the jaw members1104, 1106. As the distal-most surgical clip 1118 is received by the jawmembers 1104, 1106, the penultimate surgical clip 1118 maycorrespondingly advance distally until its crown 1210 protrudes a shortdistance out of the opening 1202. In other embodiments, however, thepenultimate surgical clip 1118 may remain entirely contained within theclip cartridge 1116 when the distal-most surgical clip 1118 has beenreceived by the jaw members 1104, 1106, without departing from the scopeof the disclosure.

Advancing the set 1204 of surgical clips 1118 distally to discharge thedistal-most surgical clip 1118 from the clip cartridge 1116 may beaccomplished by actuating (moving) a clip pusher 1210. The clip pusher1210 may comprise any type of structure capable of applying an axialload on the set 1204 and thereby moving the set 1204 distally. Forexample, the clip pusher 1210 may comprise any rigid or semi-rigid rod,shaft, or planar structure (e.g., an elongate strip-like structure), orany combination thereof. In the illustrated embodiment, the clip pusher1210 comprises a type of planar pusher bar, but could alternativelycomprise another rigid or semi-rigid structure. The clip pusher 1210 isdepicted herein as merely one example, and those skilled in the art willreadily appreciate that many different configurations of the clip pusher1210 may be employed, without departing from the scope of thedisclosure.

In the illustrated embodiment, the clip pusher 1210 is depicted as beingin contact with the legs 1212 of the proximal-most surgical clip 1118.Because of the end-to-end arrangement of the surgical clips 1118,pushing the proximal-most surgical clip 1118 will correspondingly movethe remaining surgical clips 1118 in the set 1204 in the same direction.In other embodiments, however, the clip pusher 1210 may be configured toengage any other portion of the proximal-most surgical clip 1118. In yetother embodiments, the clip pusher 1210 may be configured to engage acombination of two or more surgical clips 1118 to apply the requiredaxial load on the set 1204 to move the set 1204 distally, withoutdeparting from the scope of the disclosure.

The clip pusher 1210 may apply an axial load on the surgical clips 1118sufficient to advance the set 1204 distally and discharge thedistal-most surgical clip 1118 from the clip cartridge 1116 via theopening 1202. In some embodiments, actuation and distal movement of theclip pusher 1210 may be precisely controlled to deliver the exact amountof force and linear travel necessary to push (force) the distal-mostsurgical clip 1118 through the smaller-sized opening 1202 and feed thedistal-most surgical clip 1118 into the jaw members 1104, 1106.

In some embodiments, the clip pusher 1210 may extend proximally to adrive housing (e.g., the drive housings 206, 606 of FIGS. 2 and 6,respectively), which may include a drive input and correspondingactuating mechanisms configured to actuate (move) the clip pusher 1210as needed. In other embodiments, the clip pusher 1210 may be operativelycoupled to or otherwise form part of a clip feeding assembly including,for example, a flexible or rigid feedbar (e.g., the feedbar 418 of FIG.4) that extends from the drive housing and is actuated tocorrespondingly move the clip pusher 1210 distally and proximally asdesired.

In FIG. 12D, the head 1112 is shown as having moved (pivoted) away fromthe loading position to a clamping position. As mentioned above, theclamping position for the head 1112 may be any angular position awayfrom the loading position and relative to or aligned with thelongitudinal axis A₁. In the illustrated embodiment, for example, thehead 1112 is depicted as being aligned or substantially aligned with thelongitudinal axis A₁, but could alternatively be angularly offset fromthe longitudinal axis A₁.

The surgical clip 1118 received within the jaw members 1104, 1106 is nowready to be deployed to ligate desired body tissue, for example, a bloodvessel, a duct, a shunt, etc. Once the jaw members 1104, 1106 areproperly positioned around or at the desired body tissue, the endeffector 1102 may be actuated to collapse the jaw members 1104, 1106 andthereby crimp the surgical clip 1118 onto the body tissue.

The foregoing process of shown and described with respect to FIGS.12A-12D can be repeated until the remaining surgical clips 1118 aredepleted from the clip cartridge 1116, at which point the clip cartridge1116 may be removed to add additional surgical clips 1118. The restockedclip cartridge 1116 may then be reattached to the body 1108 for furtheroperation. Otherwise, the end effector 1102 as a whole may be replacedwith a clip cartridge stocked with additional clips.

Still referring to FIG. 12D, in some embodiments, the end effector 1102may further include one or more proximity sensors 1214 (one shown)configured to sense and/or detect adjacent body structures or tissueduring operation. In the illustrated embodiment, the proximity sensor1214 is depicted as being coupled to or positioned on the head 1112, butmight alternatively be positioned at other locations on the end effector1102. The sensor 1214 may prove advantageous in helping determine whenthe head 1112 may safely pivot between the clamping and loadingpositions without coming into contact or otherwise damaging sensitivebody structures or tissue.

The sensor 1214 may be communicably coupled (wired or wirelessly) to arobotic controller (e.g., controllers 102 a,b of FIG. 1) operated by auser, and the user may be updated in real-time as to the position of thehead 1112 relative to sensitive body tissue. The real-time updates willhelp the user safely pivot the head 1112 without contacting anythingvital or obstructing its movement.

FIGS. 13A and 13B are exposed, partial cross-sectional side views of theend effector 1102, according to one or more embodiments. Morespecifically, FIG. 13A depicts the end effector 1102 prior to crimping asurgical clip 1118 between the jaw members 1104, 1106, and FIG. 13Bshows the end effector 1102 following actuation to collapse the jawmembers 1104, 1106. The end effector 1102 includes a rotational actuator1302 a operable to move (pivot) the head 1112 between the loading andclamping positions, and further includes a linear actuator 1302 boperable to actuate the jaw members 1104, 1106 to crimp the surgicalclip 1118.

The rotational actuator 1302 a may comprise any device or mechanismcapable of or configured to pivot the head 1112 between the loadingposition and any clamping position. In the illustrated embodiment, therotational actuator 1302 a includes an articulation pulley 1304 mountedto the axle 1114 such that rotation of the articulation pulley 1304correspondingly rotates the axle 1114. A first drive cable 1306 a may berouted around the articulation pulley 1304 to cause rotation of thearticulation pulley 1304 when translated longitudinally. Since the head1112 is operatively coupled to the axle 1114, rotation of thearticulation pulley 1304, as acted upon by the first drive cable 1306 a,simultaneously causes the head 1112 to rotate in the same angulardirection.

The first drive cable 1306 a may be similar to the drive cables 808 ofFIG. 8. Moreover, the first drive cable 1306 a may extend from a drivehousing (e.g., the drive housings 206, 606 of FIGS. 2 and 6,respectively) and may be operatively coupled to a correspondingactuating mechanism or device positioned within the drive housing andconfigured to cause longitudinal translation of the first drive cable1306 a. In one embodiment, for example, the first drive cable 1306 a maybe operatively coupled to one or more capstan pulleys, such as any ofthe rotatable capstans 1002 a-f of FIG. 10. In other embodiments, thefirst drive cable 1306 a may be operatively coupled and otherwise extendfrom one or more translatable driven gears, such as the first and seconddriven gears 504 a,b of FIG. 5. In yet other embodiments, the firstdrive cable 1306 a may be operatively coupled to any combination ofcapstan pulley and driven gear, without departing from the scope of thedisclosure.

The linear actuator 1302 b may comprise any device or mechanism capableof or configured to move (collapse) the jaw members 1104, 1106 towardeach other and thereby crimp the surgical clip 1118 disposedtherebetween. In the illustrated embodiment, for example, the linearactuator 1302 b includes a jaw pulley 1308, a bevel gear assembly 1310operatively coupled to the jaw pulley 1308, and a threaded linear drive1312 operatively coupled to the bevel gear assembly 1310. Rotation ofthe jaw pulley 1308 may cause actuation of the bevel gear assembly 1310,which, in turn, may cause actuation of the threaded linear drive 1312,which operates to collapse and open the jaw members 1104, 1106.

More specifically, the jaw pulley 1308 may be rotatably mounted to theaxle 1114, but loosely mounted such that rotation of the jaw pulley 1308does not rotate or otherwise act on the axle 1114. A second drive cable1306 b may be routed around the jaw pulley 1308 to cause rotation of thejaw pulley 1308. Similar to the first drive cable 1306 a, the seconddrive cable 1306 b may be similar to the drive cables 808 of FIG. 8 andmay extend from a drive housing (e.g., the drive housings 206, 606 ofFIGS. 2 and 6, respectively) where it is operatively coupled to acorresponding actuating mechanism or device configured to causelongitudinal translation of the second drive cable 1306 b.

The bevel gear assembly 1310 may include a beveled drive gear 1314 acoupled to or forming part of the jaw pulley 1308 and a correspondingbeveled driven gear 1314 b positioned to be driven (rotated) by thedrive gear 1314 a. Moreover, the threaded linear drive 1312 may includea worm gear 1316 operatively coupled to or extending from the drivengear 1314 b, and a threaded gear plate 1318 that provides a femalethreading 1320 configured to threadably mate with or engage the helicalthreading defined on the worm gear 1316.

Example operation of the rotational actuator 1302 a and the linearactuator 1302 b is now provided. To move (pivot) the head 1112 betweenany clamping position and the loading position, and otherwise about thepivot axis P₁, the first drive cable 1306 a may be translated (moved) ineither longitudinal direction. Movement of the first drive cable 1306 arotates the articulation pulley 1304, which correspondingly rotates theaxle 1114 about the pivot axis P₁. Since the head 1112 is operativelycoupled to the axle 1114, rotation of the axle 1114 will simultaneouslycause the head 1112 to rotate in the same angular direction. Thelongitudinal movement of the first drive cable 1306 a may be preciselycontrolled to place the jaw members 1104, 1106 in the loading positionand to otherwise accurately align the jaw members 1104, 1106 with adistal-most surgical clip for loading. Likewise, longitudinal movementof the first drive cable 1306 a may be precisely controlled to positionor otherwise orient the head 1112 in a desired clamping position awayfrom the loading position.

When it is desired to crimp the surgical clip 1118 positioned betweenthe jaw members 1104, 1106, the second drive cable 1306 b may betranslated (moved) in a first driving direction, as indicated by thearrows A (FIG. 13B). As the second drive cable 1306 b translates, thejaw pulley 1308 and the drive gear 1314 a are correspondingly rotatedrelative to the axle 1114, and the drive gear 1314 a transmits arotational load to the driven gear 1314 b, which correspondingly rotatesin a first angular direction, as indicated by the arrow B (FIG. 13B). Asthe driven gear 1314 b rotates, the helical threading on the worm gear1316 interacts with the female threading 1320 on the gear plate 1318 andthereby urges (drives) the gear plate 1318 in a first linear direction,as indicated by the arrow C (FIG. 13B).

As illustrated, the jaw members 1104, 1106 comprise independent orseparate plate-like structures that are configured to move laterallyrelative to one another to collapse and crimp the surgical clip 1118.Each jaw member 1104, 1106 may provide and otherwise define one or moreangled slots 1322 that extend at an angle offset from the longitudinalaxis A₁ of the end effector 1102. While two angled slots 1322 are shownon each jaw member 1104, 1106, it will be appreciated that more or lessthan two may be employed, without departing from the scope of thedisclosure. The angled slots 1322 of each jaw member 1104, 1106 mayextend at equal but opposite angles. More particularly, the slots 1322of the first jaw member 1104 may extend at a positive angle relative tothe longitudinal axis A₁, while the slots 1322 of the second jaw member1106 may extend at a negative angle of the same magnitude relative tothe longitudinal axis A₁. As a result, depending on the axial direction,the angled slots 1322 diverge from or converge toward each other alongthe longitudinal axis A₁ of the end effector 1102.

As illustrated, one or more transition pins 1324 extend from the gearplate 1318 and extend through the angled slots 1322 of each jaw member1104, 1106 when the jaw members 1104, 1106 are installed in the endeffector 1102. The jaw members 1104, 1106 may be positioned within thehead 1112 such that they are prevented from moving axially relative tothe head 1112, but able to move laterally and thus collapse towards oneanother or open. As the rotating worm gear 1316 rotates, the gear plate1318 correspondingly moves in the first linear direction C (FIG. 13B),which simultaneously moves the transition pins 1324 in the samedirection. The transition pins 1324 slidingly engage the angled slots1322 and, because of the oppositely angled configuration of the angledslots 1322, the transition pins 1324 will urge the jaw members 1104,1106 to transition (move) laterally with respect to each other, asindicated by the oppositely directed arrows D (FIG. 13B). As the jawmembers 1104, 1106 collapse toward each other in the direction D, thesurgical clip 1118 will be crimped or crushed therebetween.

The jaw members 1104, 1106 may be re-opened to receive anotherun-crimped surgical clip by reversing the foregoing procedure. Morespecifically, the second drive cable 1306 b may be translated (moved) ina second driving direction opposite the first driving direction A, whichwill rotate the jaw pulley 1308 and the drive gear 1314 a in theopposite direction relative to the axle 1114, and the driven gear 1314 bwill correspondingly rotate in a second angular direction opposite thefirst angular direction B. Rotating the driven gear 1314 b in the secondangular direction will unthread the worm gear 1316 from the gear plate1318, which urges (drives) the gear plate 1318 in a second lineardirection opposite the first linear direction C. As the gear plate 1318moves in the second linear direction, the transition pins 1324 also movein the same direction within and slidingly engage the angled slots 1322,which urges the jaw members 1104, 1106 to separate from each other in adirection opposite the direction D.

In some embodiments, as the head 1112 is rotated via actuation of therotational actuator 1302 a, the bevel gear assembly 1310 may be affectedand may inadvertently reverse rotate as driven gear 1314 b walks alongthe drive gear 1314 a in the direction of rotation of the head 1112. Toprevent the worm gear 1316 from unintentionally advancing caused by thebevel gear assembly 1310 reverse rotating during movement of the head1112, the bevel gear assembly 1310 may be actuated to compensate for thereverse rotation. More specifically, the second drive cable 1306 b maybe actuated to back rotate the jaw pulley 1308 and the coupled drivegear 1314 a to cancel out inadvertent movement of the bevel gearassembly 1310 during movement of the head 1112. As will be appreciated,such back rotation of the jaw pulley 1308 may be automated, such asthrough a software-driven application.

The independent or separate plate-like structures of the jaw members1104, 1106 may prove advantageous in effecting parallel closure of thejaw members 1104, 1106, which dramatically reduces the force required tocrimp a surgical clip. As used herein, the phrase “parallel closure”refers to the relative parallel disposition of the opposing innersurfaces of the jaw members 1104, 1106 throughout their entire range ofmotion as the jaw members 1104, 1106 move between open and closedpositions. Parallel closure is often used with respect to medical deviceend effectors and is desirable to minimize tissue damage due tonon-uniform pressure or milking (squeezing out) of tissue from betweenopposed jaw members.

Conventional clip appliers typically include a cam that moves distallyto slidingly engage opposed and connected jaw members. As the camadvances over the jaw members, the jaw members act as individualcantilever beams as they are urged toward one another by the cam.Because the jaw members act as cantilever beams, the distal ends or“tips” of the jaw members come together first, at which point each jawmember is effectively converted into a fixed-pinned beam, whichincreases the stiffness of the system. As opposed fixed-pinned beams,the lateral force required to fully close the jaw members along thelength of the grooves defined on each jaw member increases dramatically.Consequently, this requires more expensive and powerful actuators tomove (actuate) the cam and necessitates more robust materials used tomake the jaws, the cam, and other intervening structural elements thatfacilitate jaw actuation.

According to embodiments of the present disclosure, the independent orseparate plate-like jaw members 1104, 1106 eliminate distal tip-to-tipclosure. Rather, the jaw members 1104, 1106 may be designed to achieveparallel (or substantially parallel) closure. As used herein, the term“substantially parallel” can refer to true relative parallelism betweenopposing members or near true relative parallelism, without departingfrom the scope of the disclosure. Eliminating tip-to-tip closureeliminates the need to deflect the jaw members 1104, 1106 betweensupported ends, which may prove advantageous in eliminating theadditional reaction load from the opposing jaw member and minimizing jawlength.

Parallel closure dramatically reduces the force required to collapse thejaw members 1104, 1106 and helps facilitate uniform crimping of thesurgical clip 1118. This advantageously allows smaller actuators to beused to collapse the jaw members 1104, 1106. Moreover, this allows thejaw members 1104, 1106 to be made of less-expensive materials andmanufactured through less-expensive manufacturing processes. In someembodiments, for example, the jaw members 1104, 1106 may be made of aninjection molded plastic. In other embodiments, the jaw members 1104,1106 may be made of a metal and molded through a metal injection moldingprocess. In yet other embodiments, the jaw members 1104, 1106 may bemade of a plastic or a metal and manufactured via an additivemanufacturing process (e.g., 3D printing). In even further embodiments,the jaw members 1104, 1106 may be made of a metallic base with plasticovermolding, without departing from the scope of the disclosure.

FIG. 14 is an isometric view of another example embodiment of the endeffector 1102. In some embodiments, as briefly mentioned above, therange of potential angular movement of the head 1112 about the pivotaxis P1 of the axle 1114 may be about 180°. In the illustratedembodiment, however, the range of potential angular movement of the head1112 is depicted as being potentially 360° in either angular direction.This may prove advantageous in allowing the jaw members 1104, 1106 to bearticulated to a wide range of angular clamping positions for clampingand deploying a surgical clip.

Embodiments disclosed herein include:

A. An end effector for a surgical clip applier that includes a bodyhaving a proximal end and a distal end, a clip cartridge coupled to thebody and containing one or more surgical clips, a head rotatably coupledto the distal end, and first and second jaw members mounted to the headsuch that rotation of the head correspondingly moves the first andsecond jaw members, wherein the head is rotatable between a loadingposition, where the first and second jaw members are aligned to receivea distal-most surgical clip of the one or more surgical clips, and aclamping position, where the first and second jaw members are positionedto crimp a surgical clip interposing the first and second jaw members.

B. A method of operating an end effector of a surgical clip applier, theend effector including a body, a clip cartridge coupled to the body andcontaining one or more surgical clips, a head rotatably coupled to adistal end of the body, and first and second jaw members mounted to thehead such that rotation of the head correspondingly moves the first andsecond jaw members, the method includes rotating the head to a loadingposition where the first and second jaw members are aligned to receive adistal-most surgical clip of the one or more surgical clips, advancingthe distal-most surgical clip out of the clip cartridge and receivingthe distal-most surgical clip between the first and second jaw members,rotating the head to a clamping position, and collapsing the first andsecond jaw members to crimp the distal-most surgical clip.

C. A surgical clip applier that includes a drive housing, an elongateshaft that extends from the drive housing, and an end effector arrangedat a distal end of the elongate shaft, the end effector including a bodyhaving a proximal end and a distal end, a clip cartridge coupled to thebody and containing one or more surgical clips, a head rotatably coupledto the distal end, and first and second jaw members mounted to the headsuch that rotation of the head correspondingly moves the first andsecond jaw members, wherein the head is rotatable between a loadingposition, where the first and second jaw members are aligned to receivea distal-most surgical clip of the one or more surgical clips, and aclamping position, where the first and second jaw members are positionedto crimp a surgical clip interposing the first and second jaw members.

Each of embodiments A, B, and C may have one or more of the followingadditional elements in any combination: Element 1: wherein the head canrotate about 180° relative to a longitudinal axis of the end effector.Element 2: wherein the head can rotate about 360° relative to alongitudinal axis of the end effector. Element 3: further comprising agroove defined in an inner surface of each of the first and second jawmembers, wherein the groove of each jaw member is aligned with thedistal-most surgical clip when the head is in the loading position.Element 4: wherein each surgical clip comprises a crown and a pair oflegs extending from the crown, and wherein the distal-most surgical clipis fed crown first into the first and second jaw members from the clipcartridge. Element 5: further comprising a clip pusher configured toapply an axial load on the one or more surgical clips to position thedistal-most surgical clip between the first and second jaw members.Element 6: further comprising a proximity sensor configured to senseadjacent body structures or tissue during operation. Element 7: whereinthe clip cartridge is removably coupled to the body. Element 8: furthercomprising a rotational actuator operable to pivot the head between theloading and clamping positions, and a linear actuator operable tocollapse and open the first and second jaw members. Element 9: whereinthe rotational actuator comprises an articulation pulley mounted to theaxle such that rotation of the articulation pulley correspondinglyrotates the axle, and a drive cable routed around the articulationpulley to cause rotation of the articulation pulley, wherein the head isoperatively coupled to the axle such that rotation of the articulationpulley causes the head to rotate. Element 10: wherein the linearactuator comprises a jaw pulley rotatably mounted to the axle, a drivecable routed around the jaw pulley to cause rotation of the jaw pulley,a bevel gear assembly operatively coupled to the jaw pulley, and athreaded linear drive operatively coupled to the bevel gear assembly,wherein rotation of the jaw pulley causes actuation of the bevel gearassembly, which, in turn, causes actuation of the threaded linear drive,which operates to collapse and open the first and second jaw members.Element 11: wherein the first and second jaw members compriseindependent structures movable laterally relative to one another toachieve parallel closure. Element 12: further comprising a first angledslot defined in the first jaw member and extending at a positive anglerelative to a longitudinal axis of the end effector, a second angledslot defined in the second jaw member and extending at a negative anglerelative to the longitudinal axis, wherein the negative angle is of asame magnitude as the positive angle, and a transition pin that extendsfrom a gear plate of the linear actuator and through the first andsecond angled slots, wherein actuation of the linear actuator moves thegear plate in a linear direction and correspondingly moves thetransition pin to slidingly engage the first and second angled slots andthereby urge the first and second jaw members laterally with respect toeach other, and wherein opposing inner surfaces defined on the first andsecond jaw members remain substantially parallel to each other as thefirst and second jaw members move laterally with respect to each other.

Element 13: wherein each surgical clip comprises a crown and a pair oflegs extending from the crown, and wherein receiving the distal-mostsurgical clip between the first and second jaw members comprises feedingthe distal-most surgical clip crown first into the first and second jawmembers from the clip cartridge. Element 14: wherein the head isrotatably coupled to an axle at the distal end and the method furthercomprises rotating the head between the loading and clamping positionswith a rotational actuator, the rotational actuator comprising anarticulation pulley mounted to the axle such that rotation of thearticulation pulley correspondingly rotates the axle, and a drive cablerouted around the articulation pulley to cause rotation of thearticulation pulley, wherein the head is operatively coupled to the axlesuch that rotation of the articulation pulley causes the head to rotate.Element 15: further comprising collapsing and opening the first andsecond jaw members with a linear actuator, the linear actuatorcomprising a jaw pulley rotatably mounted to the axle, a drive cablerouted around the jaw pulley to cause rotation of the jaw pulley, abevel gear assembly operatively coupled to the jaw pulley, and athreaded linear drive operatively coupled to the bevel gear assembly,wherein rotation of the jaw pulley causes actuation of the bevel gearassembly, which, in turn, causes actuation of the threaded linear drive,which operates to collapse and open the first and second jaw members.Element 16: wherein the first and second jaw members compriseindependent structures and collapsing the first and second jaw membersfurther comprises moving the first and second jaw members laterallyrelative to one another to achieve parallel closure.

Element 17: further comprising an articulable wrist joint interposingthe end effector and the elongate shaft.

By way of non-limiting example, exemplary combinations applicable to A,B, and C include: Element 8 with Element 9; Element 8 with Element 10;Element 8 with Element 11; Element 11 with Element 12; and Element 15with Element 16.

Therefore, the disclosed systems and methods are well adapted to attainthe ends and advantages mentioned as well as those that are inherenttherein. The particular embodiments disclosed above are illustrativeonly, as the teachings of the present disclosure may be modified andpracticed in different but equivalent manners apparent to those skilledin the art having the benefit of the teachings herein. Furthermore, nolimitations are intended to the details of construction or design hereinshown, other than as described in the claims below. It is thereforeevident that the particular illustrative embodiments disclosed above maybe altered, combined, or modified and all such variations are consideredwithin the scope of the present disclosure. The systems and methodsillustratively disclosed herein may suitably be practiced in the absenceof any element that is not specifically disclosed herein and/or anyoptional element disclosed herein. While compositions and methods aredescribed in terms of “comprising,” “containing,” or “including” variouscomponents or steps, the compositions and methods can also “consistessentially of” or “consist of” the various components and steps. Allnumbers and ranges disclosed above may vary by some amount. Whenever anumerical range with a lower limit and an upper limit is disclosed, anynumber and any included range falling within the range is specificallydisclosed. In particular, every range of values (of the form, “fromabout a to about b,” or, equivalently, “from approximately a to b,” or,equivalently, “from approximately a-b”) disclosed herein is to beunderstood to set forth every number and range encompassed within thebroader range of values. Also, the terms in the claims have their plain,ordinary meaning unless otherwise explicitly and clearly defined by thepatentee. Moreover, the indefinite articles “a” or “an,” as used in theclaims, are defined herein to mean one or more than one of the elementsthat it introduces. If there is any conflict in the usages of a word orterm in this specification and one or more patent or other documentsthat may be incorporated herein by reference, the definitions that areconsistent with this specification should be adopted.

As used herein, the phrase “at least one of” preceding a series ofitems, with the terms “and” or “or” to separate any of the items,modifies the list as a whole, rather than each member of the list (i.e.,each item). The phrase “at least one of” allows a meaning that includesat least one of any one of the items, and/or at least one of anycombination of the items, and/or at least one of each of the items. Byway of example, the phrases “at least one of A, B, and C” or “at leastone of A, B, or C” each refer to only A, only B, or only C; anycombination of A, B, and C; and/or at least one of each of A, B, and C.

What is claimed is:
 1. An end effector for a surgical clip applier,comprising: a body having a proximal end and a distal end; a clipcartridge coupled to the body and containing one or more surgical clips,each surgical clip having a crown and a pair of legs extending from thecrown; a head rotatably coupled to the distal end; and first and secondjaw members mounted to the head such that rotation of the headcorrespondingly moves the first and second jaw members, wherein the headis rotatable between a loading position, where the first and second jawmembers are aligned to receive a distal-most surgical clip of the one ormore surgical clips, and a clamping position, where the first and secondjaw members are positioned to crimp a surgical clip interposing thefirst and second jaw members, and wherein the distal-most surgical clipis fed crown first into the first and second jaw members from the clipcartridge.
 2. The end effector of claim 1, wherein the head can rotateabout 180° relative to a longitudinal axis of the end effector.
 3. Theend effector of claim 1, wherein the head can rotate about 360° relativeto a longitudinal axis of the end effector.
 4. The end effector of claim1, further comprising a groove defined in an inner surface of each ofthe first and second jaw members, wherein the groove of each jaw memberis aligned with the distal-most surgical clip when the head is in theloading position.
 5. The end effector of claim 1, further comprising aclip pusher configured to apply an axial load on the one or moresurgical clips to position the distal-most surgical clip between thefirst and second jaw members.
 6. The end effector of claim 1, furthercomprising a proximity sensor configured to sense adjacent bodystructures or tissue during operation.
 7. The end effector of claim 1,wherein the clip cartridge is removably coupled to the body.
 8. The endeffector of claim 1, further comprising: a rotational actuator operableto pivot the head between the loading and clamping positions; and alinear actuator operable to collapse and open the first and second jawmembers.
 9. The end effector of claim 8, wherein the rotational actuatorcomprises: an articulation pulley mounted to the axle such that rotationof the articulation pulley correspondingly rotates the axle; and a drivecable routed around the articulation pulley to cause rotation of thearticulation pulley, wherein the head is operatively coupled to the axlesuch that rotation of the articulation pulley causes the head to rotate.10. The end effector of claim 8, wherein the linear actuator comprises:a jaw pulley rotatably mounted to the axle; a drive cable routed aroundthe jaw pulley to cause rotation of the jaw pulley; a bevel gearassembly operatively coupled to the jaw pulley; and a threaded lineardrive operatively coupled to the bevel gear assembly, wherein rotationof the jaw pulley causes actuation of the bevel gear assembly, which, inturn, causes actuation of the threaded linear drive, which operates tocollapse and open the first and second jaw members.
 11. The end effectorof claim 8, wherein the first and second jaw members compriseindependent structures movable laterally relative to one another toachieve parallel closure.
 12. The end effector of claim 11, furthercomprising: a first angled slot defined in the first jaw member andextending at a positive angle relative to a longitudinal axis of the endeffector; a second angled slot defined in the second jaw member andextending at a negative angle relative to the longitudinal axis, whereinthe negative angle is of a same magnitude as the positive angle; and atransition pin that extends from a gear plate of the linear actuator andthrough the first and second angled slots, wherein actuation of thelinear actuator moves the gear plate in a linear direction andcorrespondingly moves the transition pin to slidingly engage the firstand second angled slots and thereby urge the first and second jawmembers laterally with respect to each other, and wherein opposing innersurfaces defined on the first and second jaw members remainsubstantially parallel to each other as the first and second jaw membersmove laterally with respect to each other.
 13. A method of operating anend effector of a surgical clip applier, comprising: positioning the endeffector adjacent a patient for operation, the end effector including: abody having a proximal end and a distal end; a clip cartridge coupled tothe body and containing one or more surgical clips, each surgical cliphaving a crown and a pair of legs extending from the crown; a headrotatably coupled to the distal end; and first and second jaw membersmounted to the head such that rotation of the head correspondingly movesthe first and second jaw members; rotating the head to a loadingposition where the first and second jaw members are aligned to receive adistal-most surgical clip of the one or more surgical clips; advancingthe distal-most surgical clip out of the clip cartridge and receivingthe distal-most surgical clip crown first between the first and secondjaw members; rotating the head to a clamping position; and collapsingthe first and second jaw members to crimp the distal-most surgical clip.14. The method of claim 13, wherein the head is rotatably coupled to anaxle at the distal end and the method further comprises: rotating thehead between the loading and clamping positions with a rotationalactuator, the rotational actuator comprising: an articulation pulleymounted to the axle such that rotation of the articulation pulleycorrespondingly rotates the axle; and a drive cable routed around thearticulation pulley to cause rotation of the articulation pulley,wherein the head is operatively coupled to the axle such that rotationof the articulation pulley causes the head to rotate.
 15. The method ofclaim 13, further comprising collapsing and opening the first and secondjaw members with a linear actuator, the linear actuator comprising: ajaw pulley rotatably mounted to the axle; a drive cable routed aroundthe jaw pulley to cause rotation of the jaw pulley; a bevel gearassembly operatively coupled to the jaw pulley; and a threaded lineardrive operatively coupled to the bevel gear assembly, wherein rotationof the jaw pulley causes actuation of the bevel gear assembly, which, inturn, causes actuation of the threaded linear drive, which operates tocollapse and open the first and second jaw members.
 16. The method ofclaim 15, wherein the first and second jaw members comprise independentstructures and collapsing the first and second jaw members furthercomprises moving the first and second jaw members laterally relative toone another to achieve parallel closure.
 17. A surgical clip applier,comprising: a drive housing; an elongate shaft that extends from thedrive housing; and an end effector arranged at a distal end of theelongate shaft, the end effector including: a body having a proximal endand a distal end; a clip cartridge coupled to the body and containingone or more surgical clips, each surgical clip having a crown and a pairof legs extending from the crown; a head rotatably coupled to the distalend; and first and second jaw members mounted to the head such thatrotation of the head correspondingly moves the first and second jawmembers, wherein the head is rotatable between a loading position, wherethe first and second jaw members are aligned to receive a distal-mostsurgical clip of the one or more surgical clips, and a clampingposition, where the first and second jaw members are positioned to crimpa surgical clip interposing the first and second jaw members, andwherein the distal-most surgical clip is fed crown first into the firstand second jaw members from the clip cartridge.
 18. The surgical clipapplier of claim 17, further comprising an articulable wrist jointinterposing the end effector and the elongate shaft.